Increased risk of bleeding complications in patients with Rheumatoid arthritis after first acute myocardial infarction
M Skielta, L Soderstrom, S Rantapaa Dahlqvist, A Sodergren, T MooeAbstract
Background
Rheumatoid arthritis (RA) is an autoimmune, chronic disease that mainly affects joints, cause disability and involves increased morbidity and mortality associated to cardiovascular disease. Our previous studies showed that RA per se and treatment with corticosteroids for all patients could be risk factors of death, 31-365 days after first acute myocardial infarction (AMI)(1, 2). Bleeding complications after AMI have been shown to be associated with increased mortality(3).
Purpose
We aimed to study if RA was associated with increased risk of bleeding complications after first AMI, up to 365 days.
Methods
Data for 217186 patients with a first AMI were drawn from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (SWEDHEART) for 2008-2022. The National Patient Register (PAR) was used to identify patients with RA. In total, 4814 patients were identified with RA, defined as ≥ 2 visits to a Rheumatology or Internal Medicine department with a diagnosis of RA. PAR was also used to identify bleeding events defined as: intracranial, gastrointestinal and other minor bleedings. Before the analyses, patients data were divided into two groups, those who had a bleeding complication up to 30 days after a first AMI and those who had bleeding complication from 31 up to 365 days after first AMI. Multivariable logistic regression analysis was used to identify risk factors associated with bleeding complications up to 30 days and multivariable Cox proportional hazards regression analysis from 31 up to 365 days after first AMI.
Results
Patients with RA had an increased risk of bleeding complications in both groups 0-30 days [OR 1.48, 95% confidence interval (CI) 1.16-1.88] and 31 up to 365 days after first AMI (HR 1.24, 95% CI 1.15-1.34). Further variables associated with bleeding complications for days 0-30 and for days 31-365 are presented in Tables 1 and 2.
Conclusions
The study shows that patients with RA have an increased risk of bleeding complications from 0 up to 365 days after first AMI. The study also shows that RA per se is a risk factor for bleeding complications after first AMI.